Marc MacSharry (Fianna Fail)

I welcome the Minister of State. It is good to have her here again. Fianna Fáil will support this Bill and welcomes the fact it has been introduced so quickly in order to enable the recruitment of additional doctors from overseas. The Minister of State has discussed each section in detail and I do not propose to reiterate what she said, other than to welcome the broad thrust of the Bill and acknowledge that we have a problem with the recruitment of doctors throughout the country. I would like to get some ideas on the issue throughout the debate today. All groups will support the Bill. I would like to focus on why there is a shortage of doctors and how we can ensure it does not happen in future.

Given there are 450,000 unemployed people in the country, it is unusual that we are seeking to recruit anybody from overseas for whatever discipline, whether medicine or industry. In that context I want to suggest that perhaps it is because of academic elitism and the money grabbing policies of some of our medical schools that young people who are very capable academically of undertaking various examinations, studying medicine and qualifying in various medical disciplines if they were given the opportunity to do so cannot qualify as doctors. Instead we have a points system in which the points for medicine are so high that it leads to people who are good academically at sitting exams and scoring high grades studying medicine simply because it requires higher points rather than people who are perhaps more suited to it.

I recall visiting a friend a number of years ago whose father is a GP in County Wicklow. He told me when he studied medicine in the 1960s he saw an ad in a newspaper for the Royal College of Surgeons which stated that one needed two honours in the leaving certificate and a second language in order to study medicine. He put down Irish as his native language, English as his foreign language and had two honours. He has been an exceptional GP for the community in Wicklow since.

I asked him if he would have qualified to study medicine today, given the level of points and academic demands required, and he said he would not. Having said that, he said if he worked as hard for his leaving certificate as he did for his pre-med he would have qualified. I am not sure that our system is correct. It is rumoured that the points for medicine will go up again in the coming year. It is ridiculous in the extreme to think that there are Irish HSE personnel in India and Pakistan recruiting people to come and work here at a time when we have so much unemployment. We have a bright nation of people but a system that does not support channelling those people into the medical profession.

I ask the Minister of State to explore those possibilities with the Department of Education and Skills and officials in the HSE and the Department of Health. We are too elitist about a number of academic pursuits, in terms of qualifying to enter the various medical schools in UCC or UCD. A person of lesser academic ability can enter the Royal College of Surgeons because he or she has the money to travel to this country to qualify and get the best education we can supply from a medical perspective. Such people can go abroad which creates difficulties in terms of the shortage of non-consultant hospital doctors, a problem which we are currently faced with.

Another issue is the career path for those who qualify here. Many choose to go abroad to get experience. While it is not a bad thing in itself to broaden one's horizons and try to channel the best international practices through experience back into our system, the volume is not available because the current system is not designed to ensure that we do not continue to have these difficulties in future. While physicians from India and Pakistan are very welcome, our priority should be the education of our own people so we can fill these positions. There is nothing to oppose in the Bill other than to make those points.

I ask the Minister of State and the Department of Health or the HSE to make an announcement over the weekend as to the specific hospitals that will continue to be understaffed from 11 July, in particular the accident and emergency and emergency services that will be understaffed. The people in those communities are entitled to know that if there is an incident they need to make fresh arrangements. I would also like to get assurances from the Minister of State that if medical services are being curtailed as a result of a shortage of doctors it is not used as an opportunity by the HSE to fail to restore services. Services should not be stopped as a result of a shortage of staff and not restored when staff become available. It is important to get assurances in that regard.

Yesterday I said I wanted to make a couple of points in general and will use this Second Stage debate to do so. I am sure Senator Leyden will have some things to say on Roscommon. I want to talk in a general sense about the agenda of the HSE in terms of the last Government and this Government. When I was on the other side of the House - the Minister of State can check the record - I am sure the Cathaoirleach will remember that no one was more vociferous than me in criticising the then Minister and HSE for some policies.

In the context of the north west, I am based in Sligo. We have had the Roscommon incident this week and the removal of cancer services from Sligo. There was a major campaign and people in this House would have been sick to their teeth of hearing me speak about the issue. I appealed using different angles to the then Minister Mary Harney to try to maintain the services. The agency should have been celebrating the success of the implementation of the O'Higgins report in terms of the outcomes being achieved for women with breast cancer as a result of the improvements made with the multidisciplinary approach that was introduced following its implementation in Sligo. The outcomes matched those of Sloan-Kettering in New York, where Senator Crown came from. We chose to ignore that at the time, wind down a perfectly good facility and for purely political reasons crank one up in Letterkenny which is only a few miles from Derry.

I do not want to get too political about health but one must mention that during the general election campaign a series of commitments were made about hospitals throughout the country. It gives me no pleasure to say that in Sligo there was cynical campaigning by party leaders who used an issue people are very concerned about, namely, health. The Labour Party leader and now Tánaiste, Deputy Gilmore, said in a press release in the middle of the election on, I understand, 14 February that he had "reaffirmed his party's commitment to establishment of a ninth centre of excellence". Clearly that is not going to happen. The now Taoiseach, Deputy Enda Kenny, did something similar.

Then in an interview a couple of weeks ago, the poor man hung up on the presenter when asked the question. These are the kinds of things about which I could be very political, but it is cynical to promise these things when one knows they will not come about.

Underlying all of these issues is an agenda in the HSE to wind down services in that part of the country. While all Governments, and the HSE, will state their position as wanting to provide equitable services on a regionally sensitive basis throughout the country, one wonders what is the HSE's definition of equality. Is has been my experience that the people of Roscommon, Donegal and Sligo are beginning to feel it is George Orwell's definition in Animal Farm, where some people are more equal than others. For example, Professor Hannah McGee's report on changing cardio catheterisation health which I gather is being implemented by Professor Kieran Daly recommends that there be a number of centres with cardio catheterisation laboratory facilities throughout the country, two in Dublin and one each in Galway, Cork and Limerick, although international best practice is that a high risk heart attack victim should have a stent inserted within two hours of a heart attack. If our plan is to have five of these centres throughout the country, none of which would be in the north west, what is the HSE strategy? Is it that the people of the north west should either move closer to a centre or die?

In the area of pathology, there are reports recommending that hot and cold blood facilities be centralised. It makes sense that routine blood tests be done centrally, as that would save money, but the same is not true of hot blood lab facilities. I understand it is planned to centralise hot blood laboratory facilities away from hospitals such as Sligo General Hospital which the HSE states it wishes to maintain as an acute hospital. How can one have an acute hospital with no hot lab facilities? I am not a clinician but what happens if a child presents with symptoms requiring a hot blood laboratory facility? Will the child's family be told, as happened with the child in County Leitrim who needed a liver transplant, the test cannot be done because it is the weekend or the laboratory is closed? Will the child have to move closer or die, as happens with cancer sufferers?

Senators from all parties agree that we should have centres of expertise and excellence, but we must be geographically sensitive. We must accept that people live in these parts of the country. I do not want services at every corner. That is not practical and we cannot afford it. However, it is reasonable to say people should have access to radiotherapy, a cardio catheterisation laboratory and accident and emergency services within a three hour commutable distance.

I was greatly encouraged when Deputy James Reilly became Minister for Health. I had supreme confidence in his initial moves, when he asked the board of the HSE to step aside and appointed an interim board. However, this is like firing the board of directors because the bottom line is not satisfactory. The entire management is still in place. What is the strategy? I have clearly outlined the problem in the supply of services in the north west. Is the strategy to slowly wind them down? Is Northern Ireland to be responsible for the health of the people of the north west? The people need to know.

We saw cynical campaigning with promises to restore cancer services within 100 days, maintain accident and emergency services in Roscommon and provide a ninth centre of excellence for cancer care in Sligo, as the Tánaiste promised. This maddens people and shows complete disrespect for them. I am not being party political. The people of the north west want to know what their future holds, who will provide services for them and what is the strategy to be pursued.